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12-0726 (BLCK)_ e P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 12-0!0000726 Property Address: 47330 VIA RAVENNA APN: 643-100-007-186 -26152'\- Application description:' WALL/FENCE + Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 1700 Applicant: Architect or E . •. In BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: LE G�AGT Jug os zo�Z LA LICENSED CONTRACTOR'S DECLARATION ' I hereby affirm•under penalty of perjury that I.am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: B C8 C29 License No. - 800402 at � � � Contractor: r . OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License.Law for the following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to .. construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the • permit to file a signed statement that he or she is licensed pursuant to the provisions of the'Contractor's State ' ' License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_) 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered -,for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the - improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner•builder will have the burden ofprovingthat he or she did not build or . improve for the purpose of sale.).' ' (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to•an owner of • property who builds or improves thereon, and who contract§ for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). - - • (_ 1 I am exempt under Sec. , BAP.C. for this reason - Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: j LQPERMIT MICHAEL ' 47330 VIA RAVENNA' LA=QUINTA, CA 92253 Contractor: UNITED BROTHERS CONCRETE INC PO BOX 756 THOUSAND PALMS, CA 92276 .(760)343-2861 Lic. No.: 800402 a WORKER'S COMPENSATION DECLARATION hereby affirm,under penalty of perjury one of the following declarations: _ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided . for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. - 11^ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor -Code, for the performance.of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: - Carrier GRANITE . Policy Number UNWC102569 _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any J person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3 0oft Labor Code, I shall forthwith comply with those provisions. Date: [PPlicant: / - WARNING: FAIL RE TO SE E WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND ' DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. ' APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building.and Safety for a permit subject to the ' conditions and restrictions set forth on this application. • 1.. Each person upon whose behalf this application is made, each person at whose request and for - whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City ^ of La Quinta, its officers; agents and employees for any act or omission related to the work being performed under or following issuance of this permit: . 2. Any permit issued as a result of'this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. - I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter u 6n the above-mentioned property for inspection purposes.} /Date: ignature(Applicant or Agent): s- _ 77 01 0 VOICE (760) 777-7012 FAX (760),7 77-7 011 INSPECTIONS (760) 777-71'53 : Date: 7/06/12 'Application Number 12-00000726 Permit WALL/FENCE PERMIT Additional desc•. Permit Fee39,:00 Plan Check Fee-.- 00. ` Issue Date . . . Valuation 1700 Expiration Date 1/02/13 Unit Charge Per Extension .Qty BASE FEE 15.00' . 12'. 00 2 .'0000 • HND" BLDG,• 501-2, 000 24 .-00 ----- Se-------==----=---=--=---- -------------------- p 1 Notes and :Comments ------. -- ----------- 68 L.F. COMBO WALL, ORCO SYSTEM AT -DOCK- ' AREA: PERMIT -'DOES NOT INCLUDE. DOCK CONSTRUCTION.:2010 CODES , .• -----------.--------_------------- -.Other.Fees ,°. . ." BLDG STDS ADMIN (SB1473) -1.00 'Fee summary Charged Paid Credited Due Permit Fee Total. 39.00 . .0.0 .00 39.00 �. Plan Check Total - '00 .00 .00 00., . Other Fee Total 1.00 .00 00 1.00• Grand Total .. 40.00 00 .00 40:00 " LQPERMIT -. fi, _ a - � � �f � ��.i. Attach paint chips -below and describe where ecc celor arilFSe used (i a walls, front. door, -trim, etc:): Used for -- Used for The:Appllcant uhd&sftnd dnd'ngrees.to the.foflowing I. The improv06 nts will be made instrict compliance with the approved.plans and, specification submitted with this request form $hduld any changes 'be.. required at: any time during the pro,�ect,.those changes must be approved in,advance by the Architectural Review. Committee and noted on this form. 2. Applicant -.shall hold the: Association harmless from all�liability related to any damage to' existing residences; y improvements thereon; any common property. 3. Applicatttahall comply -with Lake l,a Quinta "Architecfurnl:pesiyn Guidelines" and furnish copies of these guidelines -to the architecticontractor(s) engaged by the Applicant for the.improvement. Applicant further .understands,thatit is the applicant's responsibility to.ensure that his/her contractor(s)•also comply with these guidelines. 4. Applicant -shall sc cure.prmper building permits; if required by the local governmental entity. A,pplicdntt understands that .the City *of La Quinta may.` NOT approve any plans which hove not:Aet -been a - roved: b ' the rchi4ecturQf � Review Committee. , y PP y_74. ' 5. Applicant shall advise Association office promptly upon completion of 'the work. Applicant Signature(s): i • ---For. Association Use 09Y-------------- Committesapproved asr,*mitted. proje&Completiondate Committee approved subject to the attached conditions Committee dealed for the folfowing.attached reasons' Heid over prrtding.r+cceid! of �e ; inf afion # Applicant COMMittee Men4ber 5ignatum: 4 Wap - .. '....El .'As... k.�s .}r�►V�'�R.• `.n ....,.w-n�.��"i uti 1 .v .;. �`.�'i S. I tsln ff r rmit # �. I �,, fit' Project Address: A. P. Number: Legal Description: City of La Quinta iO' Building 8t Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 9225J; (760) 777-7012 Building Permit Application and Tracking Sheet lino 1/13 A/If/In wner's Name: Inn City Lic. ST, Zip. CL phone: i—.�!' : Description: Q A-)1' t vT Construction pe: Occupancy: P an c- Satet Lic. Pro'ect type (circle one): New Add'n Alter Repair Demo Name of Contact Person: ;Sq:.:F:t.::� # Stories: # Units: Telephone # of Contact Person: a N Submittal Plan Sets Structural Calcs. Truss CAcs. Title 24 Calcs. Flood plain- plan. Grading plan Subcontactor List Grant Deed H.O.A. Approval IN HOUSE: - Planning Approval Pub. Wks. Appr JSchool Fees I" I Total Permit Fees w �a Estimated Value of Project: 4z gn if) APPLICANT: DO. NOT WRITE BELOW THIS LINE Req'd Recd TRACKING PERMIT FEES Plan Check submitted Item Amount Reviewed, ready for corrections Plan Check Deposit Called Contact Person ,! Plan Check Balance Plans picked up Construction Plans resubmitted - Mechanical 2nd Review, ready for corrections/issue Electrical Called Contact Person Plumbing Plans picked up S.M.I. Plans resubmitted Grading 7rd Review, ready for corrections/issue,' Developer Impact Fee Called Contact Person A f P P Date of permit issue I" I Total Permit Fees w �a